Gastrointestinal Bleeding-When to call a doctor

 

Gastrointestinal bleeding couldn’t be observed as a disease, but rather as a symptom! It is an extremely common condition and possible causes of bleeding are related to conditions that can be cured or controlled, such as hemorrhoids. There are some things we should know about the anatomy of the digestive or gastrointestinal tract before we discuss the possible causes of bleeding! The digestive or gastrointestinal tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum and anus. It is logical to assume that this bleeding can come from one or more of these areas and even sometimes occurs without the person noticing it. That’s why; the fact is that probably the best method for the diagnosis is simple test of occult blood in the stool detection! The most common causes of gastrointestinal bleeding are hemorrhoids, inflammation, colorectal cancer and polyps, diverticular disease, duodenal ulcer and many others…

 

Everyone should know that the stomach acid, which is one very strong type of acid, can cause inflammation of the lower part of esophagus (food pipe) which can lead to bleeding. This condition is called esophagitis or inflammation of the esophagus. In normal occasions this is impossible, but sometimes a muscle between the esophagus and stomach fails to close properly and allows the return of food and stomach juices into the esophagus, which can lead to gastroesophageal reflux disorder. The biggest danger is when, in this condition, enlarged veins at the lower end of the esophagus may rupture and bleed massively.  

It is also important to point out that this esophageal bleeding can be caused by Mallory-Weiss syndrome. This is about a tearing in the lining of the esophagus. What is the possible cause of this tear? Well, experts are saying that it usually results from prolonged vomiting but also may be caused by increased pressure in the abdomen from coughing, a hiatal hernia or childbirth.

Every patient should be aware of the fact that the stomach is a frequent site of bleeding. Many medications such as aspirin, aspirin-containing medicines, and various other medicines can cause stomach ulcers or inflammation, as well as the consumption of alcohol! The stomach often is the site of ulcer disease. Acute or chronic ulcers may enlarge and erode through a blood vessel, causing bleeding.  The most common source of bleeding from the upper digestive tract is ulcers in the duodenum.

Everyone should know that this bleeding can also occur from benign tumors or from cancer of the stomach, but patients should know that extremely rarely these tumors cause massive bleeding.  

Almost everyone has heard about hemorrhoids, which represent probably the most common cause of visible blood in the digestive tract. They are in fact enlarged veins in the anal area. What’s also characteristic- blood that appears bright red!  

It is important to point out that the colorectal cancer is the third leading cause of cancer and cancer deaths in American men and women. The fact is also that it may cause bleeding at some time. Some other conditions also can cause bleeding and some of the most commons are ulcerative colitis, Crohn's disease, diverticular disease …

 

Logically, the signs of bleeding in the digestive tract vary significantly because depending on sites of bleeding as well as the severity. It is important to know that, if blood is coming from the rectum or the lower colon, bright red blood will coat or mix with the stool, but when there is bleeding in the esophagus, stomach or duodenum, the stool will be black or tarry. This is because blood, while passing through intestine, will be digested!   

Big problem is that, in cases when the bleeding is hidden, the patient might not notice any changes in stool color but patient may feel weak, dizzy, faint, short of breath, or have crampy abdominal pain or diarrhea.  

 

The biggest diagnostic problem is to locate the site of the bleeding. That’s why; most of the experts are saying that a complete history and physical examination could be essential in order to set the appropriate diagnosis! Like we mentioned before-bright red bleeding seen on the toilet paper or in the toilet water usually is coming from the hemorrhoid area which means lower colon or anal region! In this case- the best thing to do is to perform an endoscopy on the anus, rectum and lower colon. Problem is that this hidden or occult blood could be coming from anywhere in the gastrointestinal tract. That’s why; a professional will always use an endoscopy to check the colon firs, and if that is normal, then the esophagus and stomach should be inspected. Hemorrhage, or massive bleeding, can be from the stomach and esophagus, or from the small intestine, colon or rectum and in that case, like we already mentioned, the stool will be black and tarry! There is also one another important fact that every professional should know! Because the intake of iron can give normal stool the same appearance as stool with bleeding from the digestive tract, this should be also taken into consideration!

What exactly is endoscopy? Well, every patient should know that it is simple and extremely common diagnostic technique that allows direct viewing of the bleeding site. Although very simple, most of the doctors believe that this is probably the best diagnostic tool because the endoscope can detect lesions and confirm the presence or absence of bleeding directly. Endoscopy is done using one special instrument called the endoscope! The endoscope is one flexible instrument that can be inserted through the mouth or rectum easily and allow the doctor to see into the esophagus, stomach, duodenum, entire colon, sigmoid colon and rectum to collect small samples of tissue (biopsies). This could be extremely useful in setting the right histological diagnosis.

 

Several other methods are available to locate the source of bleeding.

Every patient should be aware of the fact that most of the doctors also prefer the barium x-ray diagnostic tool which represents a less accurate tool than endoscopy in locating bleeding sites, but also extremely effective! The barium is swallowed before the imaging and, if there are no lesions in the GI tract- then the contrast will nicely cover all GI walls!  Problem is that sometimes, this barium X-rays are that they may interfere with other diagnostic techniques if used for detecting acute bleeding.

It is important to point out that the angiography is also used to diagnose bleeding. It is one special technique that uses dye to highlight blood vessels. When it is being used? Well, experts are saying that it is most useful in situations where the patient is acutely bleeding in a way that allows the dye to leak out of the blood vessel, which identifies the site of bleeding.  

Some doctors prefer the radionuclide scanning to visualize the bleeding! It represents one technique used for locating sites of acute bleeding, and involves injection of small amounts of radioactive material after which a special camera produces pictures of organs, allowing the doctor to see the blood escaping.  

 

It is important to point out that the endoscopy isn’t just a diagnostic tool but also a therapeutic tool and that there is a great number of endoscopic useful therapies for treating GI tract bleeding. Injecting some special chemicals into the bleeding site using a needle introduced through the endoscope is one extremely useful therapeutic method! Doctor can also cauterize, or heat treat, a bleeding site and surrounding tissue with a heater probe or electro-coagulation device. Some doctors are doing also a laser therapy to stop bleeding!

 

Well, the fact is that, when the bleeding is controlled, medications often are prescribed to prevent recurrence of bleeding. It is logical to assume that medical treatment of the underlying disease, such as ulcers, to ensure healing and maintenance therapy to prevent ulcer recurrence also can lessen the chance of recurrent bleeding.  Several researches done in the past have shown that the removal of polyps with an endoscope can control bleeding from colon polyps. Removal of hemorrhoids by banding, or various heat or electrical devices is effective in patients who suffer hemorrhoid bleeding on a recurrent basis.  

·          Black or tarry stool

·          Bright red blood in vomit

·          black-grounds appearance of vomit

·          Bright red blood coating the stool

·          Dark blood mixed with the stool

·          Dizziness

·          Crampy abdominal pain

·          Feeling faint

·          Diarrhea

·          Weakness

·          Shortness of breath

·          Lethargy

·          Pallor

·          Fatigue

·          Shortness of breath